Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | XG8422951 | CA |
Y | 207Q00000X | Family Doctor | G36404 | CA |
NPI | 1124034376 |
---|---|
Provider Name | Dr. Lee Mell Goldman |
First Address | Carmel, CA 93923-8581 |
Second Address | Carmel, CA 93923-8581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 25/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A46672 | (02) | |
AG8422951 | DEA (01) | CA |